I think that we now find ourselves in an interesting place in the pandemic. We now understand very clearly the defined vulnerable groups of patients for serious disease -- elderly, obese, especially those with diabetes and immunocompromised. There are rare but serious complications of some of the vaccines in very defined segments of our population. There are clear and serious side-effects of some public health measures --- lockdowns, discouragement (intentional or unintentional) of avoiding or postponing other vaccines, cancer screenings and elective surgeries, masking of children, virtual learning. We should be in a position to make quite targeted recommendations. It makes sense to offer vaccines to those vulnerable and their family members. A 20 year old college student does not really "need" COVID vaccine, especially if previously infected. However, if she has an 18 year old sibling with a history of lung transplantation or a live-in grandparent, then she almost certainly should get a vaccine and/or booster. If a 25 year old male is living alone and hangs out with his peers, he does not "need" a vaccine, especially if he has a verified history of COVID infection or serologic evidence of natural immunity. However, if he is engaged to a woman who finished successful treatment for lymphoma, he should seek out a non-mRNA vaccine as there is a low risk for myocarditis. If he gets the mRNA vaccine, the second dose should be delayed to lessen the chance of myocarditis.
There must be a patient-specific calculation of risk and benefit. When President Biden got COVID, it made sense for him to get paxlovid. However, the White House physician should have considered an "off label" ten day course because of the high prevalence of rebound given the importance of his involvement in the affairs of our country.
When it comes to masking, I am a little more skeptical than Paul about benefits for children. The good evidence of benefit, especially of the paper surgical masks, which were never intended to prevent the transmission of infection from others to the wearer, is really lacking. Masking should likely be optional. There remain stubbornly ignorant members of society that I see every day wearing surgical masks while driving in cars by themselves and/or while walking outside in the park. Education and informed freedom is vital.
As an internist, I, too, understand well the concept of intensity mismatch. I deal in this daily.
Interestingly, VP has mentioned this concept in prior articles and podcasts, although not by this name. Just like some patients have different levels of concern to take an anti-hypertensive, they also have different levels of concern to mask, get vaccinated, and get tested. THESE are the kinds of people included in studies that represent confounding variables for which are unaccounted.
Not only the CDC, but also the FDA, the Biden admin, NEJM, Lancet, MMWR, etc. have all chosen to overlook the keen eye toward rigorous data analysis owed to the American people. My "red pill" moment was when Marion Gruber and Phil Krause voluntarily left the FDA over ethics-violation issues in the form of undue pressure from the White House...after Pfizer's CEO met with Biden.
We need a clean sweep of the positions currently filled by people who intentionally misled us. Unfortunately, that's unlikely. As my grandfather often reminded me, "gub'ment workers are like cockroaches...can't get rid of 'em."
While there might be some intensity mismatch, seems more like the public no longer trusts the authorities. The underground data revealed by these SubStack writers has arrived to the public in general who are increasingly wary of being pushed around and told that what they are observing among friends simply isn't true. At various points many were told fear would subside if only they did as directed; they did as directed in the main. Yet people still fell ill, deaths continued. Their efforts appeared futile. So many now simply shrug and go about their business. Worse many extend their doubts even to childhood vaccinations as being excessive and perhaps harmful.
I am now much more concerned that the NIH has become a corrupt shill for drug makers. The campaign against many doctors who suggested alternative solutions has been obscene. We see the conspiracy theories validated by data. We don't see authorities addressing the issues directly.
Interesting analysis. I agree with D'Ambrosio that this may be in part an intensity mismatch but is far, far more the fact that the CDC has routinely just outright lied (or skewed the data to accomplish the same thing -- think Arizona school study) and people got wise to them pretty quickly. Publishing in non-peer reviewed MMWR is not helpful because many of those articles are instantly uncredible when the data is examined -- it has become just a shill piece container. (As a many decade subscriber, makes me sad.)
Also, I have to underscore Vinay's pooh-pooh of your mask thoughts. I would love to see credible mask literature (and please do not give me Boston schools, Arizona schools, Bangladesh -- all studies easily refutable from their own data/methodologies) that shows that there is actually a credible effect from masking adults, much less children. Even mask studies in the OR show virtually no advantages. I have hundreds of articles filed that show the reverse (null value to masking for viruses) -- especially in any situation other than a mannequin in a sterile room. I have seen essentially none that can make the counterpoint. Will you please post the references?
I like the concept of intensity mismatch. I look at the CDC edicts as a one-size-fits-all centralized approach. No opportunity to provide individual care based on the unique characteristics of the patient. What other area of clinical medicine functions in this manner? People began to realize this disconnect to the “normal” way medicine was practiced and began to say - wait a minute, I have some issues and I need an answer. Having some smiling jackass on TV with a white coat and a stethoscope hanging around his neck telling you what medication you should be injected with over and over and over again ran its course to an inevitable conclusion - rejection
Dr. Fenyves, wonderful essay, and while this is the first I have heard it framed as "intensity mismatch", this certainly resonates without how I have chosen providers for myself and children and how my wife approaches her patients as a surgeon.
However, I am not convinced that Intensity Mismatch is why people have started to ignore the CDC.
The public was initially very receptive to the CDC guidance as evidenced by the strong uptake of the original series of vaccines and having one of the highest masking rates among Western countries.
The public stopped listening to the CDC because their claims have been falsified. Everyone who got vaccinated got Covid anyway. Kids in schools without masks had no different outcome than kids in masks. Every single highly vaccinated country in the world saw all-cause mortality increase after vaccinations. South Korea, once considered the model of how to fight the pandemic, with their GPS contact tracing, rolling lockdowns, mask devotion, vaccination rates, and CCTV surveillance state, now how the highest excess mortality in the world, after all-cause mortality jumped to +100% this past spring.
The CDC lost trust because it made it made incredible claims, and it turned out they were wrong, and not once has admitted error, or shown the slightest bit of humility. Instead, the agency doubles down and gaslights (see the recent fact checks on "we never said the vaccines would halt transmission").
If we saw chicken pox explode after the varicella vaccine was introduced in the 90's, you wouldn't be surprised that people stopped giving their kids the varicella vaccine.
We can't be surprised that only 10% of the public is seeking dose 4 or 5 after covid blew up in Vermont, Denmark, Japan, Israel, etc after vaccinating the public.
Had the CDC moderated intensity from the start, their credibility wouldn't be in ruins, but I am not sure this approach can help now. I'm honestly not sure what can be done, though starting with Dr. Prasad's Oct 31 piece "Pandemic accountability" is a good start.
I think that we now find ourselves in an interesting place in the pandemic. We now understand very clearly the defined vulnerable groups of patients for serious disease -- elderly, obese, especially those with diabetes and immunocompromised. There are rare but serious complications of some of the vaccines in very defined segments of our population. There are clear and serious side-effects of some public health measures --- lockdowns, discouragement (intentional or unintentional) of avoiding or postponing other vaccines, cancer screenings and elective surgeries, masking of children, virtual learning. We should be in a position to make quite targeted recommendations. It makes sense to offer vaccines to those vulnerable and their family members. A 20 year old college student does not really "need" COVID vaccine, especially if previously infected. However, if she has an 18 year old sibling with a history of lung transplantation or a live-in grandparent, then she almost certainly should get a vaccine and/or booster. If a 25 year old male is living alone and hangs out with his peers, he does not "need" a vaccine, especially if he has a verified history of COVID infection or serologic evidence of natural immunity. However, if he is engaged to a woman who finished successful treatment for lymphoma, he should seek out a non-mRNA vaccine as there is a low risk for myocarditis. If he gets the mRNA vaccine, the second dose should be delayed to lessen the chance of myocarditis.
There must be a patient-specific calculation of risk and benefit. When President Biden got COVID, it made sense for him to get paxlovid. However, the White House physician should have considered an "off label" ten day course because of the high prevalence of rebound given the importance of his involvement in the affairs of our country.
When it comes to masking, I am a little more skeptical than Paul about benefits for children. The good evidence of benefit, especially of the paper surgical masks, which were never intended to prevent the transmission of infection from others to the wearer, is really lacking. Masking should likely be optional. There remain stubbornly ignorant members of society that I see every day wearing surgical masks while driving in cars by themselves and/or while walking outside in the park. Education and informed freedom is vital.
As an internist, I, too, understand well the concept of intensity mismatch. I deal in this daily.
Interestingly, VP has mentioned this concept in prior articles and podcasts, although not by this name. Just like some patients have different levels of concern to take an anti-hypertensive, they also have different levels of concern to mask, get vaccinated, and get tested. THESE are the kinds of people included in studies that represent confounding variables for which are unaccounted.
Not only the CDC, but also the FDA, the Biden admin, NEJM, Lancet, MMWR, etc. have all chosen to overlook the keen eye toward rigorous data analysis owed to the American people. My "red pill" moment was when Marion Gruber and Phil Krause voluntarily left the FDA over ethics-violation issues in the form of undue pressure from the White House...after Pfizer's CEO met with Biden.
We need a clean sweep of the positions currently filled by people who intentionally misled us. Unfortunately, that's unlikely. As my grandfather often reminded me, "gub'ment workers are like cockroaches...can't get rid of 'em."
While there might be some intensity mismatch, seems more like the public no longer trusts the authorities. The underground data revealed by these SubStack writers has arrived to the public in general who are increasingly wary of being pushed around and told that what they are observing among friends simply isn't true. At various points many were told fear would subside if only they did as directed; they did as directed in the main. Yet people still fell ill, deaths continued. Their efforts appeared futile. So many now simply shrug and go about their business. Worse many extend their doubts even to childhood vaccinations as being excessive and perhaps harmful.
I am now much more concerned that the NIH has become a corrupt shill for drug makers. The campaign against many doctors who suggested alternative solutions has been obscene. We see the conspiracy theories validated by data. We don't see authorities addressing the issues directly.
Interesting analysis. I agree with D'Ambrosio that this may be in part an intensity mismatch but is far, far more the fact that the CDC has routinely just outright lied (or skewed the data to accomplish the same thing -- think Arizona school study) and people got wise to them pretty quickly. Publishing in non-peer reviewed MMWR is not helpful because many of those articles are instantly uncredible when the data is examined -- it has become just a shill piece container. (As a many decade subscriber, makes me sad.)
Also, I have to underscore Vinay's pooh-pooh of your mask thoughts. I would love to see credible mask literature (and please do not give me Boston schools, Arizona schools, Bangladesh -- all studies easily refutable from their own data/methodologies) that shows that there is actually a credible effect from masking adults, much less children. Even mask studies in the OR show virtually no advantages. I have hundreds of articles filed that show the reverse (null value to masking for viruses) -- especially in any situation other than a mannequin in a sterile room. I have seen essentially none that can make the counterpoint. Will you please post the references?
I like the concept of intensity mismatch. I look at the CDC edicts as a one-size-fits-all centralized approach. No opportunity to provide individual care based on the unique characteristics of the patient. What other area of clinical medicine functions in this manner? People began to realize this disconnect to the “normal” way medicine was practiced and began to say - wait a minute, I have some issues and I need an answer. Having some smiling jackass on TV with a white coat and a stethoscope hanging around his neck telling you what medication you should be injected with over and over and over again ran its course to an inevitable conclusion - rejection
I don’t know how any thinking person takes the CDC seriously any more.
Dr. Fenyves, wonderful essay, and while this is the first I have heard it framed as "intensity mismatch", this certainly resonates without how I have chosen providers for myself and children and how my wife approaches her patients as a surgeon.
However, I am not convinced that Intensity Mismatch is why people have started to ignore the CDC.
The public was initially very receptive to the CDC guidance as evidenced by the strong uptake of the original series of vaccines and having one of the highest masking rates among Western countries.
The public stopped listening to the CDC because their claims have been falsified. Everyone who got vaccinated got Covid anyway. Kids in schools without masks had no different outcome than kids in masks. Every single highly vaccinated country in the world saw all-cause mortality increase after vaccinations. South Korea, once considered the model of how to fight the pandemic, with their GPS contact tracing, rolling lockdowns, mask devotion, vaccination rates, and CCTV surveillance state, now how the highest excess mortality in the world, after all-cause mortality jumped to +100% this past spring.
The CDC lost trust because it made it made incredible claims, and it turned out they were wrong, and not once has admitted error, or shown the slightest bit of humility. Instead, the agency doubles down and gaslights (see the recent fact checks on "we never said the vaccines would halt transmission").
If we saw chicken pox explode after the varicella vaccine was introduced in the 90's, you wouldn't be surprised that people stopped giving their kids the varicella vaccine.
We can't be surprised that only 10% of the public is seeking dose 4 or 5 after covid blew up in Vermont, Denmark, Japan, Israel, etc after vaccinating the public.
Had the CDC moderated intensity from the start, their credibility wouldn't be in ruins, but I am not sure this approach can help now. I'm honestly not sure what can be done, though starting with Dr. Prasad's Oct 31 piece "Pandemic accountability" is a good start.